P4P 2006 Measurement Year / 2007 Reporting and Payment Year...
2006 Pay for Performance Results
Results for the Clinical Measures (Table 1), the Patient Experience Measures (Table 2), and the IT Measures (Tables 3-5) are included for Measurement Years 2003-2006
Final Measurement Set
The Final Measurement set is the refinement of the proposed measurement
set by the Steering and Technical Committees after considering public comment.
P4P Manual (Final Version, November 2006)
The Pay for Performance (P4P) initiative, a California statewide effort to use
standard measures to evaluate the performance of contracted POs. The goals of the endeavor are to develop
a common set of measures and publicly report scores for those measures for California POs, and to provide
health plans with the information they need for rewarding POs financially based on performance. This
is the Manual for this initiative
Summary of Changes to MY 2006 P4P Manual (November 2006)
P4P Testing Manual
These are the specifications for the testing measures to be collected in May 2007 using 2006 data. Participation in testing is optional, but highly encouraged. Based upon analysis of testing results, these measures will be considered for addition to the P4P measure set for Measurement Year 2008.
Clinical
Specifications (pages 22-57 of the P4P Manual)
The clinical quality measures are adapted from the National Committee for Quality Assurance’s (NCQA) Health Plan Employer Data and Information Set (HEDIS®1), the most widely used set of performance measures in the managed care industry. NCQA is a not-for-profit organization committed to assessing, reporting on and improving the quality of care provided by organized delivery systems. P4P also includes an audit review to ensure that results are an accurate reflection of PO performance. The audit review of the clinical measures is based on NCQA’s HEDIS Compliance Audit™ program. NCQA staff worked with P4P participants to incorporate the relevant components of the HEDIS Compliance Audit and adapt policies and procedures where necessary, and made enhancements to the process based on
each years experience. Because this program is an adaptation it is considered a Pay for Performance Audit Review, not a HEDIS Compliance Audit™. This manual includes the information needed to collect and report the clinical measures for the
reporting year P4P reporting initiative
Summary of Changes to MY 2006 Clinical Measures
Patient Experience Specifications (pages
74-81 of the P4P Manual)
A detailed set of measures and questions used to evaluate the patient's
experience with a service provider
Information Technology Specifications (pages
66-73 of the P4P Manual)
A description of the P4P information technology domain process and
measures with a glossary of terms and related data sources and
examples.
Physician Incentive Bonus (pages
82-89 of the P4P Manual)
The Physician Incentive Bonus allows a physician organization to qualify for an additional 10% on top of its total P4P score for the 3 domains: clinical, patient experience and IT.
This document describes the process to participate, scoring
methodology, provides a glossary of terms and gives related data sources and
examples.
Data Collection and Aggregation
Timeline (pages 8-9 of the P4P Manual)
A detailed timeline of events and actions to be taken for the collection
of data, data aggregation, and reporting.
Audit
Manual
P4P Audit Review Standards for POs are derived from NCQA’s HEDIS Compliance Audit Standards, the foundation on which Certified HEDIS Compliance Auditors assess a health plan’s ability to report HEDIS data accurately and reliably. These standards represent key processes involved in P4P clinical data collection and reporting.
This section includes the standards and assessments that apply to POs that opt to self-report the P4P clinical data and which are a derived subset of the HEDIS Compliance Audit Standards that health plans must meet during HEDIS audits.
HEDIS® is a registered trademark of the National Committee for Quality Assurance
(NCQA).
Baseline Assessment Tool (BAT) for download
(PDF)
Baseline Assessment Tool (BAT) for download
(MS Word Doc) Right click on this link to save to your computer)
Appeals
In spite of a thorough validation and quality assurance process, it is possible for discrepancies to be found in the final P4P results reports. Therefore, there is a formal appeals process for both POs and health plans to appeal for changes in the Final Reports.
Appeals Process(PDF)
P4P Results Appeal Form(PDF)
If you would like to download a word version of P4P Results Appeal Form, right click
here. (Choose "Save Target As...)
Top Performing Physician Organizations
A List of Top Performing Physician Organizations by
* Top Performing for Clinical Quality
* Top Performing for Patient Experience
* Top Performing for Information Technology
* Top Performing Overall
Transparency Report for Health Plan Payments
(Not
Available)
Descriptions of and guidelines for the various areas of measure
Public Comment on Proposed Measure Set
This is the proposal for the P4P measurement set which will be finalized after
public comment and resulting revisions
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